A new definition for oral health developed by the FDI World Dental Federation opens the door to a universal definition of oral health

On September 6, 2016, a new definition of oral health was overwhelmingly approved by the FDI World Dental Federation General Assembly. This was a key part of the organization’s advocacy and strategic plan – Vision 2020¹. The definition, together with a companion framework, creates an opportunity for the profession to reflect on what oral health encompasses and what the implications are of this definition for clinical practice and oral health policy. But why was a new definition needed?

Although oral health has been recognized for millennia to be an essential component of overall health and well-being, it has not been clear whether oral health has meant the same thing for different components of our profession and for our stakeholders. And if we are uncertain as a profession what we mean, how can we explain ourselves clearly to our patients, other health care professionals, policy makers, and those others we seek to collaborate with and inform? A common definition can bring stakeholders together to advocate for the importance of oral health; to influence and shape parameters of care, health policies, research, education, and reimbursement models; and to shape the future of our profession. During the creation of FDI’s Vision 2020¹, it became evident that there was a need for a universally accepted definition of oral health, one that conveys that oral health is a fundamental human right and that facilitates the inclusion of oral health in all policies. To accomplish this goal, the FDI charged a newly created Think Tank with producing such a definition.

The new definition acknowledges the multifaceted nature and attributes of oral health.

A definition was needed that included the full scope of health and well-being and, ultimately, one that could be agreed on by all. Traditionally, oral health has been defined as the absence of disease. This definition fails to account for a person’s values, perceptions, and expectations. Furthermore, existing definitions of oral health mostly lack a theoretical framework that can be used to address all of the domains and elements that are part of oral health. The new definition acknowledges the multifaceted nature and attributes of oral health (Box 1). Alongside the proposed concise definition, a companion framework was developed to describe the complex interactions among the 3 core elements of oral health (disease and condition status, physiological function, and psychosocial function), a range of driving determinants (elements that influence and determine oral health), moderating factors (factors that determine or affect how a person scores his or her oral health), and, finally, overall health and well-being (Figure 1). (A powerpoint version of the new definition of oral health and its accompanying framework can be downloaded at http://www.fdiworldental.org/oral-health/vision-2020/a-new-definition-of-oral-health.aspx.)

Box 1. Definition of oral health.

Oral health is multifaceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow, and convey a range of emotions through facial expressions with confidence and without pain, discomfort, and disease of the craniofacial complex. Further attributes of oral health:

• •It is a fundamental component of health and physical and mental well-being. It exists along a continuum influenced by the values and attitudes of people and communities.
• •It reflects the physiological, social, and psychological attributes that are essential to the quality of life.
• •It is influenced by the person’s changing experiences, perceptions, expectations, and ability to adapt to circumstances.

Figure 1.

Framework for the oral health definition. The core elements of oral health are as follows: disease and condition status refers to a threshold of severity or a level of progression of disease, which also includes pain and discomfort; physiological function refers to the capacity to perform a set of actions that include, but are not limited to, the ability to speak, smile, chew, and swallow; and psychosocial function refers to the relationship between oral health and mental state that includes, but is not limited to, the capacity to speak, smile, and interact in social and work situations without feeling uncomfortable or embarrassed. Driving determinants are factors that affect oral health and cover five main domains: genetic and biological factors, social environment, physical environment, health behaviors, and access to care. In turn, driving determinants nest within systems that can support or serve as a barrier to maintaining and promoting oral health and managing oral diseases and conditions. Moderating factors are elements that determine or affect how a person scores his or her oral health and include, but are not limited to, age, culture, income, experience, expectations, and adaptability.

In addition to the creation of a theoretical framework, there are several other advantages associated with adoption of this new definition of oral health. The new definition

• •echoes definitions used by the World Health Organization (WHO), national dental associations worldwide, and many other organizations and is, therefore, not a revolution but an evolution of existing definitions;
• •moves dentistry from treating disease to providing care and support for oral health;
• •uses language that resonates with language commonly used in the health care realm – words and concepts that health care professionals across disciplines can understand and use;
• •raises awareness of the different dimensions of oral health and emphasizes that oral health does not occur in isolation but is embedded in the wider framework of overall health.

FDI represents more than 1 million dentists through its more than 200 national dental associations in more than 130 countries; it represents dentistry at WHO and is a member of the World Health Professions Alliance and the Supporters Consultation Group of the Non-Communicable Disease Alliance². The creation of this new definition of oral health and the accompanying framework is intended to be used by all stakeholders and builds on the WHO’s Commission on Social Determinants of Health report³. Accordingly, patients, practicing dentists, academicians, researchers, politicians, third-party payers, industry partners, and medical providers were consulted and included in the creation of the definition.

Efforts are under way to assess and measure this new definition of oral health, and work in the United States has started, as demonstrated by the American Dental Association Health Policy Institute⁴. We now have a definition of oral health that will enable a conversation that creates a common understanding when addressing the needs of people and communities and when making the case for the importance of optimal oral health for all. Let’s get started.

Acknowledgements

This editorial, published in JADA, Vol 147, issue 12, Glick M, Williams DM, Kleinman DV, Vujicic M, Watt RG, Weyant RJ, A new definition for oral health developed by the FDI World Dental Federation opens the door to a universal definition of oral health, 915-917, doi: 10.1016/j.adaj.2016.10.001 © ADA (2017) is reprinted from The Journal of the American Dental Association, with permission from the American Dental Association to help disseminate the new definition of oral health to as broad an audience as possible.

Disclosure

The authors did not report any disclosures.